New guidance on hospital discharge and community support

Last week, the Department of Health and Social Care published new guidance on hospital discharge and community support. It aims to support the safe and timely discharge of people from hospital to the most appropriate place and ensure that people continue to receive the care and support they need after they leave hospital.

It specifically states that through a combination of embedding discharge to assess and utilising the national discharge fund there is an expectation that performance continues to:

• reduce the length of stay for people in acute care
• improve people’s outcomes following a period of rehabilitation and recovery
• minimise the need for long term care at the end of a person’s rehabilitation

The guidance replaces Hospital discharge service: policy and operating model first published on 21 August 2020. It applies to all NHS Trusts, community interest companies and private care providers of NHS commissioned acute, community beds, community health services and social care staff.

The DHSC explain that the new guidance has been restructured throughout, with changes to the following sections:

• section 3 (discharge to assess arrangements), more detail has been added to define the four discharge pathways;
• section 6 (finance support and funding flows) has been updated to include information about financial requirements (first published on the NHS website on 20 May 2021)
• section 7 (reporting and performance management) has been updated with hospital data collection information on discharge to explain changes that were introduced on 12 May 2021

With regard to NHS Continuing Healthcare the guidance reminds us that assessment and discussions about care planning and options should be made in a community setting. See sections 3.10-3.12, 5.6, 6.18 and 6.21 for further CHC references.

With regard to the Mental Capacity Act the guidance reminds us that a relevant mental health clinician should be involved in the discharge planning for people with a pre-existing mental health concern to ensure that their needs are considered as part of duties under the MCA. If there is reason to believe a person may lack the mental capacity to make relevant decisions, section 3 of the guidance states:

“If there is a reason to believe a person may lack the mental capacity to make the relevant decisions about their ongoing care and treatment, a capacity assessment should be carried out before a decision about their discharge is made. Where the person is assessed to lack the relevant mental capacity and a decision needs to be made, then there should be a best interest decision made for their ongoing care in line with the usual processes. If the proposed arrangements amount to a deprivation of liberty, Deprivation of Liberty Safeguards in care homes and orders from the Court of Protection for community arrangements still apply. Further information about mental capacity and deprivation of liberty during the pandemic has been published.”

With the publication of the new Health and Care Bill on 6 July we will be considering what the Bill says on hospital discharge but you can read our earlier blog on discharging patients and the NHS White Paper here.